Answers: Mains Marathon – UPSC Mains Current Affairs Questions – September 26

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Q1) At 0.83% of gross domestic product (GDP), India is among the countries with the lowest investment in scientific research especially in the medical sector. What are the challenges faced by India’s pharmaceutical research and development? What are steps can be taken by the government? GS 3

Challenges faced by India’s research and development

• One of the biggest obstacles to scientific research is the lack of sufficient funding and inadequate allocations by the government.
• At 0.83% of gross domestic product (GDP), India is among the countries with the lowest investment in scientific research.
• New medicines, devices,diagnostics, patient aids and monitoring tools are mostly imported, often coming to India several years after they are available to patients in the developed world

Intellectual property protection

• Indian patent (Amendment) act 2005 formed as per the requirements of TRIPS.The patent application process for the pharmaceutical products in India is interpreted as targeted to create burdensome for foreign applicants.

Market Access barriers

• The contribution from the government in the areas of health care is not satisfactory, which is only 1.2 percent of the GDP and healthcare infrastructure development not up to the expectation in India.

Other challenges

• India needs mere structured and matured regulations on clinical trial policies.
• More expectations are from pharmaceutical companies, as a compensation, for the person injured during clinical trials

What steps can be taken by the government?

• In order to support consistent innovation, investment has to increase substantially before any tangible outcomes can be envisioned.
• Indian pharmaceutical companies need to be supported with more financial and social capital if we are to see meaningful drug research that can address the healthcare needs of India.
• A strong patent system and robust intellectual property rights environment is required to encourage
  research and to enable foreign pharma companies to bring new products to the market.
• Short-term populist measures like imposing price ceilings do not contribute to improving patients’ access to innovative life-saving medicines and devices; a more holistic approach is needed.

Q2. Life expectancy in India on the rise, but the quality of health care services is inadequate.Discuss GS 1

Life expectancy in India has increased by more than 10 years in the past two decades, while globally children born in 2015 were expected on an average to live till 71.4 years, a new UN report revealed.

In 2015, life expectancy at birth was 68.3 years in India which breaks down to 66.9 years for men and 69.9 for women, the WHO’s World Statistics Report 2016 found.

•  In 1990, Indians were expected to live on an average till 58 years. This rose to 66 years in 2013.

What are the problems associated with increasing life expectancy?

• There is a rapid rise in the share of the old i.e. 60 years or more and associated morbidities, especially sharply rising non-communicable diseases (NCDs) and disabilities.
• Though life expectancy is increasing, but also the rate of chronic disease is increasing in older community.
• The findings of Indian Human Development Survey(IHDS) pointed out the following figures:

1-    The prevalence of  high blood pressure among the old almost doubled over the period 2005-12; that of heart disease rose 1.7 times; the prevalence of cancer rose 1.2 times; that of diabetes more than doubled, as also that of asthma; other NCDs rose more rapidly (i.e. by two and a half times).

2-    Multi-morbidities i.e., co-occurrence of two or more Non-Communicable Disease (NCDs) rose recently for like two and a half times

3-    The prevalence of high blood pressure and heart disease rose more than twice while that of high blood pressure and diabetes nearly doubled.

Global comparison:

The WHO’s World Health Statistics, annual publication since 2005 containing data from 194 countries reporting on the status of health of the world’s people depicts the following picture:

•  India has now moved considerably in the epidemiological transition or health transition where non-communicable diseases now have also become a very important cause of death,”
•  India is presented as country with particular challenges with maternal mortality and infectious diseases, but now it is grappling with newer challenges of heart strokes, obesity, cancer and diabetes.
•  In 2012, 68 percent of the deaths globally – 38 million deaths – were due to NCDs of which 52 percent were premature deaths — that are deaths of less than 70-year-olds. Over three quarters of these premature deaths were due to cardio vascular diseases, cancer, diabetes or chronic respiratory diseases.
•  India’s MMR in 2015 was 174.
•  Nepal was the highest in the SEAR group with a high of 258 deaths, while Sierra Leone topped the global list with an extremely high ratio of 1,360 mothers dying per 1,00,000 live children born
•  A related statistic shows that between 2006 and 2014, 74 percent of the Indian children were born through skilled personnel while the same percentage for Thailand is 100, while it is as high as 99 percent for Sri Lanka.
• India has about 24 skilled health personnel to serve 10,000 people. This rate is globally comparable only with Latin American countries like Peru and Nicaragua.
• Life expectancy for children born in 2015 was 71.4 years globally.
• Health life expectancy stands at 63.1 years globally.

Q3)The National Health Policy, 2017, was approved by the Union Cabinet which will replace the previous policy adopted in 2002.  Critically analyse the key features of this policy  and also suggest measures. GS 2

Ans:The National Health Policy, 2017, was approved by the Union Cabinet which will replace the previous policy adopted in 2002.

What are the key highlights of National Health Policy?

• The broad principles of the Policy are centered on professionalism, integrity and ethics, equity, affordability, universality, patient centered and quality of care, accountability and pluralism.
• It aims to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence.
• It intends on gradually increasing public health expenditure to 2.5% of the GDP.
• It proposes free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
• The policy advocates allocating two-thirds (of resources to primary care.
• It proposes two beds per 1,000 of the population to enable access within the first 60 minutes after a traumatic injury.
• To reduce morbidity and preventable mortality of non-communicable diseases (NCDs) by advocating pre-screening.
• It highlights AYUSH as a tool for effective prevention and therapy that is safe and cost-effective.
• It proposes introducing Yoga in more schools and offices to promote good health.
• It also proposed reforming medical education.
• The policy also lists quantitative targets regarding life expectancy, mortality and reduction of disease prevalence in line with the objectives of the policy

What are the key targets?

•  Increase Life Expectancy at birth from 67.5 to 70 by 2025.
•  Reduce Fertility Rate to 2.1 by 2025.
•  Reduce Infant Mortality Rate to 28 by 2019.
•  Reduce under Five Mortality to 23 by 2025.
•  Achieve the global 2020 HIV target (also termed 90:90:90 global targets).
•  To reduce premature mortality from cardiovascular diseases, cancer,diabetes or chronic respiratory diseases by 25 per cent by 2025.

• Reducing the prevalence of blindness to 0.25 per 1000 persons by 2025.
• The disease burden to be reduced by one third from the current levels.
•  Elimination of leprosy by 2018, kala-azar by 2017 and lymphatic filariasis in endemic pockets by 2017.

What are the positive aspects of this policy?

•  The policy seeks to promote universal access to good quality healthcare services and a wide array of free drugs and diagnostics.
•  The proposed steps such as a health card for every family will certainly help improve health outcomes in India.
•  The recommended grading of clinical establishments and active promotion and adoption of standard treatment guidelines can also help improve the quality of healthcare delivery in India.

What are the loopholes?

•  The policy duplicates portions of the Health section of Finance Minister’s 2017 Budget speech, reiterates health spend targets set by the erstwhile Planning Commission for the 12th Five Year Plan.
•  It fails to make health a justiciable right in the way the Right to Education 2005 did for school education. A health cess was a path breaking idea that was proposed in the draft policy but it was dropped.
•  Whether Health should continue to be in the State List or in the Concurrent List is not answered in the policy.
•  Lack of capacity to use higher levels of public funding for health.

What should be done?

•  More health professionals need to be deployed for primary care in rural areas.
•  Contracting of health services from the private sector may be inevitable in the short term.
•  No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels.
•  Without oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance. For the new policy to start on a firm footing, the Centre has to get robust health data.
•  To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone.